PT Glossary

The total amount of money owed to a practice for services rendered but not yet collected from patients or insurance payers.

A formal request to an insurance company to reconsider a denied claim or prior authorization decision.

The practice of billing a patient for the difference between the provider's charge and the amount paid by insurance.

A legally required contract between a HIPAA-covered entity and a vendor that handles protected health information (PHI).

The percentage of claims submitted that are accepted by the payer on the first submission without errors or additional information required.

Current Procedural Terminology codes — a standardized system of 5-digit codes used to describe medical, surgical, and diagnostic services for billing purposes.

The process of verifying a healthcare provider's qualifications, licenses, certifications, and insurance participation to ensure they meet payer and regulatory requirements.

The systematic process of identifying, analyzing, and resolving denied insurance claims to recover lost revenue.

The CMS billing guideline that determines how many timed units a therapist can bill based on the total minutes of direct one-on-one treatment provided.

The process of confirming a patient's insurance coverage, benefits, copay, deductible status, and authorization requirements before providing services.

A document from an insurance company explaining how a claim was processed, including what was paid, denied, and what the patient owes.

A CMS requirement for reporting functional limitations and therapy outcomes using standardized G-codes and severity modifiers on Medicare claims.

The Health Insurance Portability and Accountability Act — federal law establishing national standards for protecting sensitive patient health information.

International Classification of Diseases, 10th Revision — the standardized coding system used to describe diagnoses and medical conditions on insurance claims.

A billing modifier indicating that the therapist has documented that services are medically necessary and reasonable beyond the Medicare therapy cap threshold.

The clinical justification that a healthcare service is reasonable and necessary for the diagnosis or treatment of a patient's condition.

The annual dollar threshold for outpatient therapy services under Medicare, above which services require additional documentation and the KX modifier.

A two-character code appended to a CPT code to provide additional information about the service performed, such as the body part treated or the circumstances of the service.

Federal legislation protecting patients from unexpected medical bills for out-of-network services received at in-network facilities or in emergency situations.

A unique 10-digit identification number assigned to healthcare providers by CMS, required for all HIPAA-covered transactions including billing.

Standardized assessment tools used to quantify a patient's functional status, pain levels, and treatment progress at specific points during the episode of care.

A documented treatment plan that outlines the patient's diagnosis, functional limitations, treatment goals, interventions, frequency, and expected duration of therapy.

A requirement by insurance companies for providers to obtain approval before delivering certain services, ensuring the services are medically necessary and covered under the patient's plan.

Any individually identifiable health information created, received, maintained, or transmitted by a HIPAA-covered entity or business associate.

Strategies and tools used to actively involve patients in their own care, including appointment reminders, home exercise programs, and self-service portals.

A two-digit code on insurance claims that identifies where the healthcare service was provided, affecting reimbursement rates.

The end-to-end financial process of managing claims, payments, and revenue generation from patient registration through final payment collection.

A recommendation or order from a physician or other qualified provider directing a patient to receive physical therapy services.

A standardized documentation format used by healthcare providers consisting of four sections: Subjective, Objective, Assessment, and Plan.

A detailed invoice or receipt that lists all services provided during a patient visit, including CPT codes, ICD-10 codes, and charges, used for insurance claim submission.

The delivery of physical therapy services remotely using video conferencing and digital communication tools.

The process by which insurance companies evaluate the medical necessity and appropriateness of healthcare services to determine coverage and payment.

A healthcare delivery model where providers are reimbursed based on patient outcomes and quality metrics rather than the volume of services provided.

A state-mandated insurance program that provides medical benefits and wage replacement to employees injured on the job, including physical therapy services.